title: [Total trans-oral endoscopic thyroidectomy and cervical lymphadenectomy: a human cadavers surgery study].
abstract: OBJECTIVE
  To find an approach for trans-oral endoscopic thyroidectomy (TOET) and cervical lymphadenectomy using conventional endoscopic surgical instruments on frozen fresh cadavers.
  
  
  METHODS
  Six frozen fresh cadavers were used in three groups of trans-oral trocar installation experiments: oral vestibule installation, sublingual region installation, and combined bi-vestibular and sublingual installation. TOET (with pretrachealis method to thyroid fixation removal) and cervical lymphadenectomy were performed experiments on another 6 frozen fresh cadavers using the best access approach found in the aforementioned experiments.
  
  
  RESULTS
  In oral vestibule trocar installations, the trocars caused large lacerated wound and damaged air tightness. In sublingual installations, only one trocar could be installed in the sublingual area because the space in sublingual area was limited. In combined bi-vestibular and sublingual installations, no gland, vessel or nerve was damaged. Combined bi-vestibular and sublingual access were selected as the surgical approach on the basic of analysis the merits of each approach. TOET and cervical lymphadenectomy in area III, IV, VI, VII were performed without making any accessory damage through combined bi-vestibular and sublingual access approach.
  
  
  CONCLUSIONS
  TOET is feasible. Combined bi-vestibular and sublingual approach is available for TOET. Part of the cervical lymph nodes could be resected. Pretrachealis approach to thyroid fixation removal can still be used.
authors.affiliation: Minimally Invasive Center, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, Guangdong Province, China.
authors.forename: Yuan-Hang
authors.initials: YH
authors.lastname: Su
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Tang
authors.forename: Zi-Hai
authors.initials: ZH
authors.lastname: Ding
authors.forename: Hua-Qiao
authors.initials: HQ
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.forename: Jian-Shen
authors.initials: JS
authors.lastname: Liang
authors.forename: Hong
authors.initials: H
authors.lastname: Cen
authors.forename: Xiang-Wen
authors.initials: XW
authors.lastname: Zhao
authors.forename: Ji-Wei
authors.initials: JW
authors.lastname: Ding
authors.forename: Wei
authors.initials: W
authors.lastname: Hua
authors.forename: Cong
authors.initials: C
authors.lastname: Tang
mesh_terms: D000328:Adult; D002102:Cadaver; D004724:Endoscopy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D009333:Neck; D013965:Thyroidectomy / Q000379:methods*